不同针灸疗法治疗寻常痤疮的网状Meta分析

Different Acupuncture Therapies for Treating Acne Vulgaris: a Network Meta-analysis

目的 采用网状Meta分析方法,评价针刺、火针、艾灸等不同针灸疗法对寻常痤疮(acne vulgaris,AC)临床有效率及复发率的影响。方法 计算机检索PubMed、Embase、Cochrane、Web of Science、CINAHL、中国知网(China National Knowledge Infrastructure,CNKI)、万方数据库(WanFang Data)、中国生物医学文献数据库(China Biology Medicine disc,CBM)和维普中文期刊服务平台(VIP Database),搜集针灸疗法治疗寻常痤疮的随机对照试验(randomized controlled trail,RCT),检索时间均为建库至2021年3月,文献筛选、资料提取及偏倚风险评价均由两名研究者独立进行。数据分析使用Stata16.0软件。结果 纳入42项RCT,共3911例寻常痤疮患者。数据分析结果显示,临床总有效率:艾灸、放血、放血+穴位注射、放血+针刺、火针优于西药(P<0.05),放血、放血+穴位注射、放血+针刺、火针、穴位埋线优于针刺疗法(P<0.05),放血+针刺疗法优于自血疗法(P<0.05),累计排序概率曲线下面积(surface under the cumulative,SUCRA)显示放血+针刺治疗寻常痤疮总有效率最高;复发率:放血疗法+穴位注射优于电针(P<0.05),SUCRA结果显示针刺+自血疗法治疗寻常痤疮复发率最低。结论 放血联合针刺疗法在提高总有效率上具有最好的疗效,针刺联合自血疗法可有效降低复发率,受纳入研究所限,以上结论尚需更多大样本、高质量RCT进一步验证。

Objective To assess the effectiveness of acupunctures in treatment of acne vulgaris by using network metaanalysis.Methods PubMed, Embase, Cochrane, Web of Science, CINAHL, CNKI, WanFang Data, CBM and VIP were searched from inception to March 2021 to collect RCT on acupuncture therapies for patients with acne vulgaris. We screened literature and extracted data. The evaluation of literature quality were conducted independently by two researchers. Stata 16.0 software was used for statistical analysis.Results A total of 42 RCTs were included, involving3911 patients with acne vulgaris. The results of NMA showed that for the clinical effects, moxibustion, bloodletting,bloodletting plus acupoint injection, bloodletting plus acupuncture, and red-hot needling were superior to western pharmacological therapy(P<0.05). Bloodletting, bloodletting plus acupoint injection, bloodletting plus acupuncture, redhot needling, and catgut embedding were superior to simple acupuncture(P<0.05). Bloodletting plus acupuncture was superior to self-blood therapy(P<0.05). SUCRA values based on clinical effects showed that bloodletting plus acupuncture was the best. Bloodletting plus acupoint injection was superior to electroacupuncture in recurrence rate(P<0.05). SUCRA values based on recurrence rate showed that acupuncture plus self-blood therapy was the best.Conclusion Bloodletting plus acupuncture has the highest possibility to improve overall efficiency, acupuncture plus self-blood therapy can effectively reduce the recurrence rate. Due to limited study quality, the above conclusions need to be further verified by more large-sample and high-quality studies.